Open wounds should be cleaned and a sterile dressing applied The fracture should be immobilized Prophylactic intravenous antibiotics should be administered, and tetanus prophylaxis should be given according to the standard guidelines Current antibiotic recommendations are for the administration of early, systemic, wide-spectrum antibiotic therapy directed at gram-positive and gram-negative organisms A commonly recommended regimen is for a firstgeneration cephalosporin (e.g., cefazolin) with the addition of an aminoglycoside (e.g., gentamicin) for larger open fractures (skin laceration >1 cm with significant soft tissue damage and gross contamination) As an alternative to aminoglycosides, a third-generation cephalosporin or other agent with activity against gram-negative bacteria may be selected For injuries at high risk for anaerobic infection (e.g., occurring on a farm), clinicians should add ampicillin or penicillin Urgent orthopedic consultation is necessary for surgical debridement, irrigation, and definitive care of the wound and fracture If there is suspicion for compartment syndrome, compartment pressures in the injured extremity should be obtained; however, this may be difficult in an awake young child, especially if less than years old Compartment pressures >30 mm Hg have been used to diagnose compartment syndrome Newer approaches suggest that compartment pressures should be interpreted in the context of systemic blood pressures Compartment pressures within 30 mm Hg of either the diastolic blood pressure or the mean arterial pressure are concerning for compartment syndrome Urgent orthopedic consultation is necessary if there is any concern for compartment syndrome, which may require treatment with fasciotomy Disposition All children with open fractures or with concern for/diagnosis of compartment syndrome should be admitted to the hospital for ongoing orthopedic care given the high risks for infection and neuromuscular injury MULTIPLE TRAUMA CLINICAL PEARLS AND PITFALLS